An interprovincial comparison of unintentional childhood injury rates in Canada for the period 2006-2012

Home injuries in British Columbia: patterns across the deprivation spectrum

The significant burden of home injuries has become a growing concern that affect thousands of people every year across Canada. This study examined the relationship between neighbourhood deprivation and unintentional injuries occurring at home leading to hospitalizations in British Columbia (BC) between 2015 and 2019. This study used de-identified hospitalization data on unintentional home-related injuries from the Discharge Abstract Database (DAD) and population data for each dissemination area from Statistics Canada's 2016 Census Profiles. Hospitalization rates were computed for unintentional home-related injuries across four dimensions specified in the Canadian Index of Multiple Deprivation (CIMD) for BC. For three CIMD dimensions (situational vulnerability, economic dependency, and residential instability), unintentional home injury rates were higher in areas with higher deprivation, while the inverse was observed for ethno-cultural diversity. Understanding socio-economic disparities within neighbourhoods enables injury prevention partners to identify vulnerable populations and prioritize the development and implementation of evidence-based injury prevention interventions.

Epidemiology and factors associated with mortality among pediatric major trauma patients in Nova Scotia: A 17-year retrospective analysis

BACKGROUND

Major traumatic injury in the pediatric population requires further evaluation to improve patient outcomes. Relatively few Canadian studies have investigated pediatric trauma using population-based data. Our objectives were to describe the epidemiology of pediatric major trauma in Nova Scotia and identify factors associated with in-hospital mortality.

METHODS

Retrospective cohort study of pediatric major trauma patients (age <18 years) injured in Nova Scotia over a 17-year period (April 2001-March 2018). Data were collected from the Nova Scotia Trauma Registry. Characteristics were compared between patient subgroups using t-tests, chi-square analyses and Fisher's exact test. Temporal trends were evaluated using the Mann-Kendall test. Incidence and mortality rates were mapped using ArcGIS Pro. A multivariate logistic regression model was created to assess for factors associated with in-hospital mortality.

RESULTS

A total of 1258 injuries were observed over the 17-year study period. The incidence of pediatric major trauma was 41.7 per 100,000 person-years. Most patients were male (819/1258; 65.1 %) and resided in urban areas (764/1258; 60.7 %). Blunt trauma accounted for 86.2 % (1084/1258) of injuries, and motor vehicle collisions were the most common cause (448/1258; 35.6 %). Incidence and mortality rates were highest in the 15-17 year age group, with a trend towards increasing incidence among females (p = 0.011). Mortality was 17.2 % (217/1258) of patients; 10.9 % (137/1258) died pre-hospital. No trends were detected in mortality rates. The regression model showed increased odds of in-hospital mortality for every point increase in the ISS (OR 1.05; 95 % CI 1.02 to 1.09) and for every unit decrease in scene GCS (OR 0.63; 95 % CI 0.56-0.71). Rural patients were 2 times more likely to die in-hospital versus urban patients (OR 2.40; 95 % CI 1.01-5.69), and patients injured at home were 6 times more likely to die compared to those injured in other locations (OR 6.19; 95 % CI 1.01-38.11).

CONCLUSION

Pediatric trauma remains a major public health issue in Canada and beyond. Greater efforts are required to expand our understanding of trauma epidemiology and develop targeted injury prevention strategies, especially for rural inhabitants.

A Pilot Randomized Trial Evaluating the Cool 2 Be Safe Junior Playground Safety Program for Preschool Children

OBJECTIVE

Unintentional injury is the leading cause of death to children worldwide, and playgrounds pose a significant risk of injury. Those aged 5 and 6 years are particularly vulnerable to playground injuries. Previous interventions have typically targeted environmental modifications or increased supervision to reduce playground injuries; however, minimal research has focused on implementing behavioral interventions that seek to change children's safety knowledge and risk-taking behaviors on the playground. The current randomized trial addressed these gaps in the literature and sought to increase preschool children's hazard awareness skills and knowledge of unsafe playground behaviors and decrease their intentions to engage in risk-taking behaviors on the playground.

METHOD

A total of 77 children aged 5 and 6 years were tested at a laboratory on a university campus, using a parallel group design, with 38 randomized to the playground intervention group and 39 randomly assigned to a control group. The intervention was manualized and delivered to small groups of children (3-5) over several sessions.

RESULTS

Statistical analyses revealed significant group differences. Intervention experience led to significant increases in hazard awareness skills and knowledge of unsafe playground behaviors, and significant decreases in children's risk-taking behavioral intentions, whereas those in the control group showed no significant changes in these scores. Attention scores for those in the intervention group highlighted that the program content was successful in maintaining children's attention and engagement, and memory scores indicated excellent retention of lesson content.

CONCLUSION

The program shows promise in addressing the issue of unintentional playground injuries in young children.

A 2-year prospective evaluation of airway clearance devices in foreign body airway obstructions

Aim

To collect, analyze and report the first prospective, industry-independent, data on airway clearance devices as novel foreign body airway obstruction interventions.

Methods

We recruited adult airway clearance device users between July 1, 2021 and June 30, 2023 using a centralized website and email follow-up. The data collection tool captured patient, responder, situation, and outcome variables. Multi-step respondent validation occurred using electronic and geolocation verification, a random selection follow-up process, and physician review of all submitted cases.

Results

We recruited 186 airway clearance device users (LifeVac©:157 [84.4%]; Dechoker©:29 [15.6%]). LifeVac© was the last intervention before foreign body airway obstruction relief in 151 of 157 cases. Of these, 150 survived to discharge. A basic life support intervention was used before LifeVac© in 119 cases, including the 6 cases where LifeVac© also failed. We identified two adverse events using LifeVac© (perioral bruising), while we could not ascertain whether another 7 were due to the foreign body or LifeVac© (3 = airway edema; 3 = oropharyngeal abrasions; 1 = esophageal perforation). Dechoker© was the last intervention before obstruction relief in 27 of 29 cases and all cases survived. A basic life support intervention was used before Dechoker© in 21 cases, including both where Dechoker© also failed. We identified one adverse event using Dechoker© (oropharyngeal abrasions).

Conclusion

Within these cases, airway clearance devices appear to be effective at relieving foreign body airway obstructions. However, this data should be considered preliminary and hypothesis generating due to several limitations. We urge the resuscitation community to proactively evaluate airway clearance devices to ensure the public remains updated with best practices.

Validation of ICD-10 codes for studying foreign body airway obstructions: A health administrative data cohort study

Aim

To validate a case definition for foreign body airway obstructions (FBAO) using International Classification of Diseases version 10 (ICD-10) codes to accurately identify patients in administrative health databases and improve reporting on this injury.

Methods

We identified prehospital patient encounters in Alberta, Canada between Jan 1, 2018 and Dec 31, 2021 by querying the provincial emergency medical services' (EMS) patient care records for FBAO-related presentations, EMS protocols, or treatments. We deterministically linked EMS patient encounters to data on emergency department visits and hospital admissions, which included ICD-10 codes. Two physicians independently reviewed encounters to determine true FBAO cases. We then calculated diagnostic accuracy measures (sensitivity, specificity, likelihood ratios) of various algorithms.

Results

We identified 3677 EMS patient encounters, 2121 were linked to hospital administrative databases. Of these encounters, 825 (38.9%) were true FBAO. The combination of two ICD-10 codes (T17 = foreign body in the respiratory tract or T18.0 = foreign body in the mouth) was the most specific algorithm (96.9% [95%CI 95.8-97.8%]), while the combination of all FBAO-related ICD-10 codes and R06.8 (other breathing abnormalities) was the most sensitive (75.0% [95%CI 71.9-78.0]). We identified an additional 453 (35.4%) FBAO cases not transported by EMS (due to death or transport refusal), and therefore not linked to the hospital administrative databases. Of these unlinked encounters, 44 (9.7%) cases resulted in the patient's death.

Conclusions

FBAO can be identified with reasonable accuracy using health administrative data and ICD-10 codes. All algorithms had a trade-off between sensitivity and specificity, and failed to identify a third of FBAO cases, of which 10% resulted in death.

The Association between Comorbidities and Comorbid Injuries on Treatment Outcome in Pediatric and Elderly Patients with Injuries in Korea: An Observational Study

We aimed to compare the characteristics and types of injuries affecting pediatric and elderly patients and to identify factors associated with treatment outcomes. We used data from the 2006−2017 Korea National Hospital Discharge Survey. The patients were divided into two groups, children (0−12 years) and elderly (≥65 years), based on their age at discharge. In total, 47,528 (11,842 children and 35,686 older adults) patients with injuries were identified. The number of deaths and the LOS were 36 (0.3%) and 7.6 days (±10.1), respectively, in the children group, and 861 (2.4%) and 18.5 days (±27.3), respectively, in the elderly group (p < 0.001). In the children group, there were increased odds for surgery among boys, Medicaid and health insurance subscribers, patients with multiple injuries, patients without a subdiagnosis, and an increasing number of hospital beds. In the elderly group, there were increased odds for surgery among women, Medicaid and health insurance subscribers, patients who died, patients with a single injury, patients with a subdiagnosis, and increasing numbers of hospital beds. Treatment outcomes could be improved by providing early diagnosis and prompt treatment in pediatric patients and by taking multilateral approaches for multiple injuries and comorbidities in elderly patients.

Self-reported injuries among Canadian adolescents: rates and key correlates

INTRODUCTION

Injuries sustained by adolescents in Canada represent a costly public health issue. Much of the limited research in this area uses administrative data, which underestimate injury prevalence by ignoring injuries that are not treated by the health care system. Self-reported data provide population-based estimates and include contextual information that can be used to identify injury correlates and possible targets for public health interventions aimed at decreased injury burden.

METHODS

The 2017 wave of the Canadian Community Health Survey was used to calculate the prevalence of self-reported total, intentional and unintentional injuries. We compared injury prevalence according to age, sex, employment status, presence of a mood disorder, presence of an anxiety disorder, smoking and binge drinking. Analyses were performed using logistic regression to identify significantly different injury prevalence estimates across key correlates.

RESULTS

Overall past-12-month injury prevalence among adolescents living in Canada was 31.4% (95% CI: 29.4%-33.5%). Most injuries were unintentional. All provinces had estimates within a few percentage points, except Saskatchewan, which had substantially higher prevalence for both overall and unintentional injury. Smoking and binge drinking were significantly associated with higher injury prevalence in most jurisdictions. Remaining correlates exhibited nonsignificant or inconsistent associations with injury prevalence.

CONCLUSION

The data suggest that injury prevention interventions aimed at reducing alcohol consumption, particularly binge drinking, may be effective in reducing adolescent injury across Canada. Future research is needed to determine how provincial context (such as mental health support for adolescents or programs and policies aimed at reducing substance use) impacts injury rates.

Phase One of a Global Evaluation of Suction-Based Airway Clearance Devices in Foreign Body Airway Obstructions: A Retrospective Descriptive Analysis

Background: Choking is a prevalent source of injury and mortality worldwide. Traditional choking interventions, including abdominal thrusts and back blows, have remained the standard of care for decades despite limited published data. Suction-based airway clearance devices (ACDs) are becoming increasingly popular and there is an urgent need to evaluate their role in choking intervention. The aim of this study was to describe the effectiveness (i.e., resolution of choking symptoms) and safety (i.e., adverse events) of identified airway clearance devices interventions to date. Methods: This retrospective descriptive analysis included any individual who self-identified to manufacturers as having used an ACD as a choking intervention prior to 1 July 2021. Records were included if they contained three clinical variables (patient’s age, type of foreign body, and resolution of choking symptoms). Researchers performed data extraction using a standardized form which included patient, situational, and outcome variables. Results: The analysis included 124 non-invasive (LifeVac©) and 61 minimally invasive (Dechoker©) ACD interventions. Median patient age was 40 (LifeVac©, 2−80) and 73 (Dechoker©, 5−84) with extremes of age being most common [<5 years: LifeVac© 37.1%, Dechoker© 23.0%; 80+ years: 27.4%, 37.7%]. Food was the most frequent foreign body (LifeVac© 84.7%, Dechoker© 91.8%). Abdominal thrusts (LifeVac© 37.9%, Dechoker© 31.1%) and back blows (LifeVac© 39.5%, Dechoker© 41.0%) were often co-interventions. Resolution of choking symptoms occurred following use of the ACD in 123 (LifeVac©) and 60 (Dechoker©) cases. Three adverse events (1.6%) were reported: disconnection of bellows/mask during intervention (LifeVac©), a lip laceration (Dechoker©), and an avulsed tooth (Dechoker©). Conclusion: Initial available data has shown ACDs to be promising in the treatment of choking. However, limitations in data collection methods and quality exist. The second phase of this evaluation will be an industry independent, prospective assessment in order to improve data quality, and inform future choking intervention algorithms.

A Protocol for the Prospective Evaluation of Novel Suction-Based Airway Clearance Devices in the Treatment of Foreign Body Airway Obstructions

Background

Foreign body airway obstructions (FBAOs, choking) are a significant cause of preventable mortality. Abdominal thrusts, back blows, and chest compressions are traditional interventions. However, suction-based airway clearance devices (ACDs) have recently been marketed as an alternative. Of note, there is limited published evidence regarding their efficacy and safety. Our research has two aims: (1) to investigate what situational and patient factors are frequently identified, and which are associated with relief of the FBAO and survival in individuals with FBAOs treated with an ACD; and (2) to describe the experience of individuals who have used ACDs in response to a FBAO and identify facilitators and barriers to the use of ACDs compared to traditional interventions.

Methods and analysis

A prospective database will be developed using an online reporting system to capture ACD uses, independent of manufacturers, from July 1st, 2021 to December 31st, 2023. Descriptive statistics will be used to summarize cases, outcomes, and adverse events. Clinically important subgroups will be stratified for analysis, including the severity of obstruction, patient demographics, and training of ACD users. Semi-structured interviews will also be conducted with a subset of ACD users to describe in detail their experience using the device. Themes from these interviews will be assessed using the theoretical domains framework.

Discussion

This study will improve the evidence surrounding ACDs and compare it to current data for traditional techniques, with the aim of optimizing FBAO treatment. Data on ACDs are urgently needed as these devices are already being used by parents, caregivers, lay rescuers, and healthcare professionals to respond to choking emergencies. This evaluation will provide important information about their effectiveness and any safety concerns which can inform the public, resuscitation guidelines, and future research studies.

Death in childhood and adolescence: Accident!

In childhood and adolescence periods, individuals encounter many dangerous situations caused by not completing their biological and psychological development. Some of them are pathological deaths such as accidents, poisoning, and traumatic actions for children. Awareness of the number and causes of death is an indicator that reflects the health status of our society. It is also vital in-service planning for both preventive and therapeutic medical professions. The purpose of this article is to evaluate death cases between the ages of 0-18 in terms of forensic medicine. As a result, it has been understood that accidents are an important cause of death in childhood. In particular, developing policies to protect against common accidents will reduce the mortality rates of children.

A systematic review on the effectiveness of anti-choking suction devices and identification of research gaps

AIM

Despite an obstructed airway (choking) being a relatively preventable injury, it has a considerable mortality burden globally, with increasing incidence. Given new technologies in choking management, this systematic review aimed to assess current literature on the effectiveness of anti-choking suction devices at relieving obstructions.

METHODS

Ovid MEDLINE, Embase, PubMed, The Cochrane Library, SCOPUS, Web of Science, CINAHL Plus and the English websites of the devices were searched on September 23, 2019. Studies were included if they reported the anti-choking devices' dislodgment success rate (primary outcome) or associated adverse events (secondary outcome). Articles, conference abstracts or technical reports were included if peer reviewed. Certainty of evidence was assessed in accordance with GRADE.

RESULTS

Five studies satisfied the inclusion criteria for this review. Two studies (40%) reported findings of a single centre mannequin trial, one (20%) of a single centre cadaveric trial, and two (40%) were case series. Cohen's Kappa for the first and second round of screening was 0.904 and 0.674 respectively. Although several devices have been manufactured worldwide, the LifeVac© has been most extensively studied, with a combined dislodgement success rate of 94.3% on first attempt. However, certainty of evidence for the primary outcome was evaluated as very low.

CONCLUSIONS

There are many weaknesses in the available data and few unbiased trials that test the effectiveness of anti-choking suction devices resulting in insufficient evidence to support or discourage their use. Practitioners should continue to adhere to guidelines authored by local resuscitation authorities which align with ILCOR recommendations.

Childhood road traffic injuries in Canada - a provincial comparison of transport injury rates over time

Background

In Canada, road traffic injuries are the leading cause of death among children and youth ≤19. Across the country, there is variability in road traffic injury prevention policies and legislation. Our objective was to compare pediatric road traffic related injury hospitalization and death rates across Canadian provinces.

Methods

Population-based hospitalization and death rates per 100,000 were analyzed using data from the Discharge Abstract Database and provincial coroner’s reports. Road traffic related injuries sustained by children and youth ≤19 years were analyzed by province and cause between 2006 and 2012.

Results

The overall transport-related injury morbidity rate for children in Canada was 70.91 per 100,000 population between 2006 and 2012. The Canadian population-based injury hospitalization rates from all transport-related causes significantly decreased from 85.51 to 58.77 per 100,000 (− 4.42; p < 0.01; − 5.42; − 3.41) during the study period. Saskatchewan had the highest overall transport related morbidity rate (135.69 per 100,000), and Ontario had the lowest (47.12 per 100,000). Similar trends were observed for mortality rates in Canada.

Conclusions

Transport-related injuries among children and youth have significantly decreased in Canada from 2006 to 2012; however the rates vary by province and cause.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6269-9) contains supplementary material, which is available to authorized users.